Are teenagers key to beating meningitis?

Meningitis is a potentially life-threatening inflammation of the lining of the brain and spinal cord. The most common symptoms are headache, fever, neck stiffness, vomiting and an inability to tolerate bright light and loud noises.

The disease can be caused by bacteria or viruses and may lead to serious long-term consequences. These include hearing loss, epilepsy, hydrocephalus and learning difficulties. Bacterial meningitis, especially meningococcal disease, is particularly serious.

A number of vaccines can prevent meningitis. These include vaccines targeting meningococcal, pneumococcal and Haemophilus influenzae type b (Hib) infections.

Vaccines against meningitis C, Hib and pneumococcal invasive disease are routinely given to babies in many European countries. Vaccination against pneumococcal disease is also recommended for older people by several national health authorities. (Check your national vaccine schedule here)

Recently a new vaccine against meningitis B was added to the childhood vaccine schedule in the UK and Ireland, while the Czech Republic offers the jab at several life stages.

Because childhood immunisation schedules are well-established and familiar to parents and health professionals, kids have traditionally benefited from newly-introduced vaccines.

New research

It has long been known that adolescents are susceptible to meningitis in the community with potentially devastating consequences, including death. This is why they have been a target group for meningitis prevention programmes such as the Men C vaccine.

Now scientists say there is reason to believe that teenagers might be the most important group in the fight against bacterial meningitis. By vaccinating adolescents, not only do we protect the vaccinated individuals, we also protect others by curbing the spread of the meningitis-causing bacteria in the community.

The new study by the Global Meningococcal Initiative was published in Expert Review in Vaccines, a medical journal. This international group of expert scientists, doctors and public health officials emphasised the need for herd protection.

They concluded that vaccinating the age groups most likely to carry the meningitis bacteria – namely adolescents and young adults – is important for achieving whole population protection.

So how exactly could vaccinating a teenager help their younger sibling or grandparent? The answer lies in herd immunity.

The authors of the new paper say the herd effect can already be seen in the UK where vaccinating teenagers and young adults against meningitis C led to a dramatic decline in cases in all other age groups.

The same could be true for meningitis B but it is not possible to say because the MenB vaccine is new and not widely used in adolescents.

Still, patient advocates welcomed the new study and, as MenB is the largest remaining cause of meningitis in many European countries, the prospect of unlocking community-wide protection is a tantalising one.

“Adolescents aged between 14 to 18 are more likely to carry meningococcal bacteria than any other age group,” said Linda Glennie, Head of Research at Meningitis Research Foundation (MRF). “Vaccinating young adults should protect them and stop the bacteria from being passed on to others. This means that even unvaccinated people will be protected from catching the disease.”

The MRF welcomed the addition of the MenB vaccine to the UK infant immunisation schedule in 2015 but is concerned that this will not prevent the majority of cases. “A commitment was made to evaluate the MenB vaccine in teenagers and we hope that this report from the GMI gives further impetus to begin the process of funding of the teenage evaluation,” Dr Glennie said.

Daphne Holt, Vice President of the Confederation of Meningitis Organisations (CoMO) also welcomed the report. “I am delighted that the importance of herd protection is gaining more attention,” said Dr Holt, who is a member of the Vaccines Today Editorial Board. “With international travel increasing and new strains emerging, it is more crucial than ever that vaccination programmes are targeted to those who have the highest carriage rates.”

Watch: a guide for health professionals talking to parents about the new MenB vaccine. The vaccine is more likely to cause fever than most childhood vaccines. Parents need to be prepared for this and advised on the prophylactic use of paracetamol.